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Miscellaneous - 9 Royal Crest
32 Date TOWN OF NORTH ANDOVER PERMIT FOR WIRING . ..... ...... This certifies that..... ....................... . V1 .1.4 ... has permission to perform ... ... I ............................ 0 . -A .......... . . . ... .... . . .. .. ......................................... wiring in the building of..:........W4.. ...... .................................................... nt .... .... . q. -V! ....... ...................................... rth Andover Mass. .......... Fee ........... Lic. No. !!.....111 ....... .. .... �LEC 1�!C�AL iN��SP�E O� Check # 1309P Commonwealth of Massachus t� Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Permit No. Official Use Only 13a2� Occupancy and Fee Checked Zev.1/07] (leave hlankl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATIOl9 Date: D e - C 9%)q City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or lief intention to perform the Location (Street & Number) rR Owner or Tenant AM, C r KAc-,r i h 'A ry iJG ire'y* LAU Owner's Address oo workd cribed below. C1 elen oneNo., Is this permit in conjunction with building permit? Yes ❑ No LTJ (Check Appropriate Sox) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: N O -e -Y- e-te Con n -e c-kt orl' 5 it„i 3k o&ebmro( e-ker:(-►zic 14e,A, Une V'oltnQ� �,err,o s �� IS C.,-nc(- (terUv%+ bd 6 r S fk�celv�� Gln e S t4 , % . L, C Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ITO.—Of rnd. grnd. Emergency.Lig ting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons J.KW ......... No. of Self -Contained Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.. of Dryers Heating Appliances KW Security Devils : or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value ofElectricalWork: 16 (When required by municipal policy.) Werk to Start: mA 1 iL- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME:. 1-') 4 tt1 iceV. 64e-- L'_ I c �� �_c �_ - LIC. NO.: 1A Licensee: (>yi w t.) Signature (If applicable enter "exempt" in the license number line.) Address: (ct6 D POl= S-- W0Jk, o +A . N 1: *Per M G L c 147 s 57-61 security work LTC. NO.: :3 1 �j 56 C �� I Bus. Tel. No.— Alt. Tel. No.:.� clic Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent _ Signature Telephone No. EPUMITFEE.- $Z The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www mass.gov/dia triciansfPlumbers Workers' Compensation Insurance ;Affidavit: Builders/Contractors/Elglease Print LeM Applicant Information `� e, P\ I i� Name (Business/organization/Individual):-LJ�` V 1I Address: A 0 �) Or �--_ Is Cit,/State/ZipA 0C U_k1C'--byl MA- 09ILS1_ Are you an employer? Check the appropriate box: tf 4. ❑ I am a general contractor and I 1. ❑ I am a employer with employees (full and/ox part-time).* have hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and'haveno employees working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no employees. [No workers' insurance required.] t comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. t Momeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tGontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. If man employer that is providing workers' compensation insurance for my employees: Below is the policy and job site information. //�� � (� ����y r^�y1 C_ Insurance Company Name: t—t � .L Expiration Date: Policy # or Sel£ ins. Lic. #: W Job Site Address: 5 6 -(�C L(CLA 1 rL City/State/Zip: IA 4430 6blC r Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500a d and/or the violator.ear s Be advised that a copy of this statement maybe forwarded to the ffice of ent, as well as civil penalties in the form of a STOP -WORK ORDER d a fine of up to $250.00 a day against Iny,estigations of the DIA for insurance coverage verification. Ido hereb cert under thepains andpenalties ofperjury that the information provided above is true and correct. 1.J _ n 'i;--> \i Date: a t �))(4- h Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: t BOAtiID Of FIFeTRIGIANS `��� COMMONWEALTH OF MA�aA�HUSETT:S E ELECTRIC ANS ISSUES THE FOLLOWING LICENSE s� AS R . . . . . . . . . . . R16 JOURNEYMAN, ....:D AN -L)EI-L P VITALS tz 190 DALE ST' —:Uj 4 1 377-5 WALTHAM MA' 02 5 di 31850»:.07/3]1;1:6:;:>:::::`::: :35002 A0 A CERTIFICATE OF LIABILITY INSUR ANCF 8/26/14 END F ALTER THE COVERAGE AFFORDED BY THE POLICIES ° SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER CHI �tTIFICATE IS IS AUTHORIZED �CATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS , E CERTIFICATE HOLDER. RESENTAl1VE OR PRODUCER, AND THE olic les must be endorsed. If SUBROGATION IS WAIVED, subject o PORTANT: If the certificate holder is an ADDITLONAL INSURED, the p VOis ' ons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to e rhe terms and conditions certificate holder in lieu of such endorsement(s)- CONTACT LESLIE HANNON —0587 NAME: FAX (978) 667 PROW CER PHONE (97A% 667-6150 Al No: James O'Connell Insurance Agen EMAIL JIMINS@OCONNELLINS.COM NAIC # ADDRESS: 572 Boston Rd INSURE IS AFFORDING COVERAGE Unit 7 INSORERA:Merchants Billerica, MA 01821 INSURER B : A. I M. Insurance INSUREDI NSU RER C : DANIEL, P VITAL- ELECTRIC INSURER D: 190 DALE ST MA 024'51 INSURER F, �TAI'THAM, INSURER F REVISION NUMBER: IOD COVERAGES CERTIFICATE NUMBER: WH R CONDITION OF ANY CONTRACT OR OTHERDOHEREEN IS SUBJECT NT WITH PTO ALLECT THE TERMS, I THIS IS TO CERT IFY THAT THE POLICIES OF IN 'LISTED BELOW HAVE BEEN ISSUED TO THE INS ED NAMED ABOVE FOR THE POLICY PER INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE OLI B POLICIES DESCRID CL EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH OLLI suBRLIMITS SHOWN MAY HAVE BEEN REDUCED EFFYYBYY PMD CLAIMS. ILTR POLICY NUMBER TYPE OF INSURANCE IN R WVD BOP9098053 9/12/14 9/12/15 EACH OCCURRENCE $ 1 OOO OOO pAMAGETO RENTED $ 500 000 A GENERALLIABILITY 15 000 { MED EXP (Arty one person) $ {i X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR PERSONALBADVINJURY $ 1 000 OOC + GENERAL AGGREGATE $ 2 OOO OOC I PRODUCTS - COMP/OPAGG $ 2 000 ,00( $ ,--i nrrREGATE LIMIT APPLIES PER rnKARINFD SINGLE LIMIT AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS _ AUTOS UMBRELLA LIAB EXCESS LIAB �COMPENSATION ED RETENTIOP B WORANDANY Mandatory -n NH)MBER I If YYes describe under nFSLRIPTION OF OPERATIC OCCUR CLAIMS -MADE YIN NIA 10/11/13I 10/11/14 WCC5006538012009 DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Rerrerks Schedule, if more space is requred) FT.EC RICAL WORK N. 'a TOWN OF NORTH ANDOVER MA 120 MAIN ST NORTH ANDOVER, MA 01845 LESLIE HANNON © 1988 2010 A�1 The AC ORD name and logo registered marks of ACORD 4 ACORD 25 (2010105) Fax: I Phone: �1 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER—Y D GM/A E $ (Per accident) $ EACH OCCURRENCE $ nr,GREGATE I$ 10010( 100101 500,01 CANCELLAI wN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF THE EX I ATIO WITH THE POLICY OF,PRONOTICE WILL BE DELIVERED ACCORD CE AUTHORIZED REPRESENTATIVE e RD CORPORATION. All rights reg NORTH ANDOVER BUILDING DEPARTAIE T 1600 Osgood Stmet North Ajidover - Tel: 978-688-9545 Fax: 978-688-9542 BUS SS FORM .FOR TO WN CLERK DATE: �-D l �c-f � �. Y(O m AiNAS. _._-� . -, 4- KONMGMSTRICT: TYE OF BUSINESS.' BU.ILINNG LAYOUT JPR0VIEC6: YES AYAILA LE PA IC G ,SJ'ACM: ZONMGBYLAS'USAGE: YES NO RUM13ING JNPPECTC OR SIGNA.TUPIE BUSINESS FORM FOR TOWNCLERA FQ 2.40 Rome Occupation (1989/32) .An accessory use conducted within a dwelling by a resident who. resides in the dwellnng as. his principal address, which is clearly secondaTy t,o the use• of the -building.-for for living piuposes, Home occupations shall `include, not'limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacfuring of goods, whi& impacts die residential nature of the neighborhood' 4. For use of a dwellitag in any residential district or multi-faanily district for a hoarse occupation, the following conditions shall apply. a. Not more than a total of flue& 3)r people may be'q iployed in tho1ibine occupation, one of whom shall be the owner offine home occupation and residing in paid ds��elfing; b. The use is carried on strictly within.the principal building; c. There shall be no exterior alterations, accessory buildings, or display which -are not customw with residential buildings; d. Not more than twenty-five (25) percent of the existing gross floor area of the dwelling unit. so used, not to exceed one thousand (1.000) square feet; is devoted to 'such use. In connection vaith such use, there is to be kept no stock in trade, commodities or products Which occulty space beyond these limits; e. .There will be no display ofgoods or wares visible from the street; £ The building"iir premises occupied shall not be rendered objectionable or, daWmmtat to the. , residential character of the, neighborhood due to the exterior appearance, emission of odor, _gas, -smoke, dusk noise, disturbance, or in any other wale become objectionable 'or detrimental to any residential use within the neighborhood; g. Any such buildingshall include no features of desiga not customaay in buildings for residential Use. Date a - w "ORTh Otit�av � �h0 M NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street Building 20 Suite 2-36 North Andover �/ �'sste •��t5 �SSALNUS� Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE: 3/3/2015 NAME: Christopher Fillippi ADDRESS: 9 Royal Crest Drive Apt3 ZONING DISTRICT: �J TYPE OF BUSINESS: IT Sollutions BUILDING LAYOUT PROVIDED: YES AVAILABLE PARKING SPACES: f�/� ZONING BY LAW USAGE: YES -73`5 PZj&e- S�feJW11-5 BUILDING INSPECTOR SIGNATURE: Ft 7�� Kv—e,"- BUSINESS FORM FOR TOWN CLERK M 0 2.40 Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use of the building for living purposes. Home occupations shall include, but not limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said dwelling; b. The use is carried on strictly within the principal building, c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more than twenty-five (25) percent of the existing gross floor area of the dwelling unit so used, not to exceed one thousand (1000) square feet, is devoted to such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. Signature 0 Date (S L .? 9944 Date........ .-'..7v..//..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that G�..............�T& ie i R A:- S .............................................................. has permission to perform ...�4 Gr %'�� L /��,/L Y.......................................... wiring i the buildin of ............................................................... °. at� ....ow. . �1....!1.�...... .Jh Andover, MMass. Fee .... 5 . Lic. No...10.737./-V ............ A.' % ELECrRICALINSPECCOR Check # 7 4 (fommonwea& o f Maidac4aieth 2.pad.d of Jim �ervice� BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No.T Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: March 4, 2011 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 50 Royal Crest Drive Building # CJ Owner or Tenant Royal Crest Apartments Telephone No. 978-681-1822 Owner's Address 50 Royal Crest Drive North Andover. MA 01845 Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building_ Commercial - Apartment Buildinasutility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install 6 Gell Packs! No. of Meters No. of Meters Comoletinn ofthe following tnhle may he waived by the In—r-P nfW'ivac No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- 11 rnd. rnd. o. o Emergency Lighting Battery Units 6 No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number I.TonsKW ........................ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Munic'pal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of o. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Devices Wiring: No. of or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: —$600.00 (When required by municipal policy.) Work to Start: 03/04/2011 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: The Electricians & Co. Inc. LIC. NO.: A10737 Licensee: Michael J. Parziale Signature LIC. NO.: E20269 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-322-9344 Address: 50 Branch Street Malden, MA 02148 Alt. Tel. No.: 781-322-3100 *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. SS CO 001021 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE. $ 125.00 Signature Telephone No. Date. /Z%.......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION J^1 L This certifies that .. .............. . has permission for gas installation c4 c in the buildings of . eala .// . cqrt�5.....,rS/ ,1 ............. at ...!'�ly+�ls�'�.. S?�'............ . . North Andover,; Mass. Fee.c,✓rc. Y. Lic. No..////.... . � ... . GAS INSPECT R Check # 8017 D� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ®O GAS FITTING City/Town:. G� U Date: e m► ...... .. � t : .�._ ... Perm Building Locatic1w' I^� � � - � Owners Name: ij�)qad Type of Occupancy: Commercial Educational)—] Industrial"�� Institutional � Residential New:C [ Alteration: Renovation Replacement:Clans Submitted: Yes No L= INSURANCE COVERAGE:�• I have a current liabilityinsurance policy or Its substantial equivalentwhich meets the requirements of MCL: Ch. 942 Yes��No�,,._ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Bond U OWNER'S INSURANCE WAIVER: I am aware that, the licensee does not have the insurance coverage required by Chapter 942 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only OwnerEI Agent Signature of Owner or Owners Agent By checking this box ❑; I hereby certify that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the best of my nowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertint provislon of the Massachusetts State Plumbing Code and Chapter 942 of the General La r._........._ 4" -Type of License: BY'..401 -� Plu r as Fitter Title, Master ..'.. Journeyman Cltyffown!........... .... :.:......_:..........-•.:,:..,..,,::,.,:>..,...:,:...` LP Installer APPROVED (OFFICE USE ONLY) _ i•: = SWature of Licenseff Plumber/Gas Fitter License Number: ►' ' „ ' '" FIXTURES Cn ud Uj � z 1— U) t/) LLJ U � a 03 = 0 F_ O _� z O � ul � W n LGU O h < W O U z U) > W Z 0 W O d U n. w t°' W > 0 U I w N d w z O _1 w 19 i= W O. (n z -j 0 ttt O z. F` (n U- O = w i -Z - z B W Q z >- O lY w ¢ W d W W In Q a O o to z 141 O v® n U_ a O an oc > SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3Ku FLOOR 4 FLOOR 5 FLOOR 6 FLOOR s 7 FLOOR.. B FLOOR One Only Certificate # Installing Company Name: tv� ���� . ........s �Chheeck Corporation Address: City/Town: State:'' I P__�Flrm/Gompany Partnership _._ZP_...ode:t Business Tel: ell: ... . Name of Licensed P[umber/Gas Fitter:.. - o\ M INSURANCE COVERAGE:�• I have a current liabilityinsurance policy or Its substantial equivalentwhich meets the requirements of MCL: Ch. 942 Yes��No�,,._ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity Bond U OWNER'S INSURANCE WAIVER: I am aware that, the licensee does not have the insurance coverage required by Chapter 942 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only OwnerEI Agent Signature of Owner or Owners Agent By checking this box ❑; I hereby certify that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the best of my nowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertint provislon of the Massachusetts State Plumbing Code and Chapter 942 of the General La r._........._ 4" -Type of License: BY'..401 -� Plu r as Fitter Title, Master ..'.. Journeyman Cltyffown!........... .... :.:......_:..........-•.:,:..,..,,::,.,:>..,...:,:...` LP Installer APPROVED (OFFICE USE ONLY) _ i•: = SWature of Licenseff Plumber/Gas Fitter License Number: l%e... Date. -?A. TOWN OF NORTH ANDOVER 0'. PERMIT FOR PLUMBING This certifies that ... F. ! ...................... has permission to perform .... ...........//............ plumbing in the buildings of ...P.6'!/!. ( ... ( rtf7s. ........... at—s-o c.lvA f�..c In i.� ....... . North Andover, Mass. Fee.g�. Lic. No...... 3 0 6/ ........ ....... PLUMBING INSPECTOR Check # am 11 V MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS n Building Location J f Cr •Zja Date �' • Permit # << 7 --}� f � " C-O%Amount � Owner. � `�•��' New Renovation Replacement Plans Submitted Yes ® No FIXTITRF.q (Print or type)6 � Check one: Installing Company Name ' 111 � 1 ❑ Corp. r Partner. Firm/Co Name of Licensed Plumber: F V\.tm c \,\ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity ❑ Bond u -Certificate Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature IOwner Agent I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa Ste Plumb' od d Chapter 142 of the General Laws. By: igna e ol'LicenfUrTurriVer Type of Plumbing License Title O 6 City/Town i ease Tum er Master ❑ Journeyman APPROVED (OFFICE USE ONLY The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box - 1. ❑ 'I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees- [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other —�—rr--_.••-- •.••••• ••••••.•........;. ra mus: ais.i lut uut LBC SeC.'nOy Qeinus 5.^.C�.nng +.Hort Y,,.. wen:e:s' comsa oa policy �.ro. �en. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractots must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the information policy and job site Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Sob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): ' 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pernait or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to Zany business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance' for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govldia Date. T Of .14, . 6 40 0 TOWN OF NORTH ANDOVER 4 4 PERMIT FOR GAS INS4-ALLATION of 9S SACH 5 Et This certifies that .......................... has permission for gas installation L4 .14 ................... in the buildings of ...... y�. ................ JL at .. North Andover, Mass. Fee.Acr.. Lic. No..'3.0(�L .. ..... GAS INSPECTOR Check # -2 V //)- C-;' 7120 V MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Rou C ` e e/t N1 M -C& Owner's Name New ❑ Renovation ❑ Replacement Date :2— 70A Permit # // L U Amount $ `j-' Plans Submitted ❑ �re)�, Name Name of Licensed Plumber or Gas Fitter % % Check one: Certificate Installing Company Corp. rPartner. ® Firm/Co. INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes,f. Nor If you have checked Les, please irldicate the type coverage by checking the appropriate box. Liability insurance policy Vr Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ® Agent �— y ��l Lily uiai all u, uro ucwm� auu miormauon i nave suomir<ea (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett�ate'Gas Code aiq Chapter 142 of the General Laws. own I I J-iCYKV V 1✓L) (OFFICE USE ONLY) I Signature oT Licensed Plumber Or Gas Fitter Plumber Gas Fitter Liceffse Num er ❑ Master (��/ Journeyman x w a 4 V) F W O z z O O E. w W F Ga z a a w a A. O a> w.. w w v w F w v x Cz� F W z > F W z C4 F v z O z O x Q cccc m o w w a Q 3 c U Q� U a > c a H O SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. FLOOR 3RD . FLO O R 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. F L O O R STH. FLOOR �re)�, Name Name of Licensed Plumber or Gas Fitter % % Check one: Certificate Installing Company Corp. rPartner. ® Firm/Co. INSURANCE COVERAGE Check o I have a current liability Insurance policy or it's substantial equivalent. Yes,f. Nor If you have checked Les, please irldicate the type coverage by checking the appropriate box. Liability insurance policy Vr Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ® Agent �— y ��l Lily uiai all u, uro ucwm� auu miormauon i nave suomir<ea (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusett�ate'Gas Code aiq Chapter 142 of the General Laws. own I I J-iCYKV V 1✓L) (OFFICE USE ONLY) I Signature oT Licensed Plumber Or Gas Fitter Plumber Gas Fitter Liceffse Num er ❑ Master (��/ Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, M4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: 1 Ao, �.�✓� �. h. . City/State/Zip: Are you an employer? Check the appropriate box: #: ( 17.0 2.-3411 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs qe ] 13.0 Other 7777--7-7 * Sny applicant that checks box #1 must also Bill out the section below showing their worke:e' comp; s=- O-- policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: - Policy # or Self -ins. Lic. Expiration Date: Job Site -Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct �'1 1 A In Phone #: Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 2-11-M Contact Person: Phone #: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 0^ployees (full and/or part-time).* have hired the sub -contractors 2r I am a sole proprietor or partner- listed on the attached sheet I " ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp insurance re d Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs qe ] 13.0 Other 7777--7-7 * Sny applicant that checks box #1 must also Bill out the section below showing their worke:e' comp; s=- O-- policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: - Policy # or Self -ins. Lic. Expiration Date: Job Site -Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct �'1 1 A In Phone #: Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 2-11-M Contact Person: Phone #: Information and Instructions Massachusetts, General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to .this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of. another who employs persons•to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shallnot.because of such employment bedeemed to be an employer." f 'Ili MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of z license or Itch to; operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptableevidence of compliance with the insurance requirements of this chapter have been presented to. the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes, that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city ar town that the application for the pernait or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemrit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit The Office of Investigations would like to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,°telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MAS.SAFE Fax # 617-727-7749 Revised 5-26-05 vmm,.mass..gov/dia DelleChiaie, Pamela From: Sawyer, Susan Sent: Thursday, April 27, 2006 11:08 AM To: DelleChiaie, Pamela Cc: Grant, Michele Subject: response so far - 9 Royal Crest Drive #12 Additional Information based on converstion with Patti Perdue at 10AM 4/27/06 Background - Work was being done to improve efficiency for electric usage. National Grid suggested new lighting system - sent people to insulate the attic and broke through the ceiling. Royal Crest first hired Marcor to come in to test for asbestos, but Ms. Epstein called DEP. DEP withdrew the Marcor permit. and requested RC use ATC 781 932-9400 (06-0257). Took 50 samples. RC says as of today 4/27/06 no results have been given to them. I attempted to call ATC, but was having phone difficulties getting through. Patti Purdue says that Ms. Epstein is coming in at 11:00AM to talk to Patti Perdue about moving to a new apartment. Called an left message for Ms. Epstein in the AM. -----Original Message ----- From: DelleChiaie, Pamela Sent: Wednesday, April 26, 2006 4:41 PM To: Sawyer, Susan Subject: 9 Royal Crest Drive #12 Hi, Here is the summary from the call: Linda Epstein [Sawyer, Susan] apt.9-12 of above apartment called re: asbestos in her apartment. She was asked to leave apartment last Wed., 4/19/06, and is currently in Peabody at: 978.535.4194. Property Management was doing insulation work. A worker fell through ceiling, and broke ceiling in two separate places/2 rooms. Apartment is on the top floor. Management company did 6 air samples and 50 wipes for any asbestos. All came back negative. Caller gave me two names: Dept. of Env. Protection, Joe Paparello, and DEP, John McLuskey. They had told management company to use ATC & Associates to do the sampling. Told Joe to cleanup the two rooms. Caller thinks whole apartment should be cleaned up. Also wants to know if she should be tested for asbestos exposure. It is unclear how caller got names from agencies - whether she called on own or was given them. Patti Perdue - 978.681.1822 - Property Manager. 8asf R¢gwods, pA�eea neee�e��afa Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA o1845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com